Discussion

A continuous fight against malaria requires a variety of specific interventions suitable to local needs. Amodiaquine (AQ) in combination with artemisinin (ASAQ) has been used in a number of West African countries as first line treatment in addition to artemither-lumefantrine (AL). Sulphadoxine-pyrimethamine (SP) has also been used in intermittent prevention treatment (IPTp) in pregnant women and as seasonal malaria chemoprevention (SMC) together with AQ. SMC has been shown to be an effective tool to prevent malaria in children under 5 years in areas where incidence of clinical cases is strictly seasonal. Implementation of this strategy during the rainy season has been shown to reduce cases of malaria in this age group by 65-80%, depending on setting. Monitoring the development and spread of drug resistance is particularly crucial for large-scale interventions such as SMC and IPTp. This is also needed where ASAQ is in use as a first line of treatment. The scaling up interventions in order to reduce malaria cases and deaths will require monitoring of the development of resistance to SP+AQ. In the Access-SMC programme, more than 30,000 samples have been collected before the scale-up of SP+AQ administration in seven countries in the Sahel: Burkina Faso, Chad, Guinea-Conakry, Niger, Nigeria, Mali and The Gambia. A large cross-section of these baseline samples from each country are being genotyped to identify mutations at pfcrt, pfmdr1, pfdhfr and pfdhps known to impact on the efficacy of AQ or SP. A summary of PCR-determined prevalence of Plasmodium falciparum and baseline resistance genotyping data from each country will be presented.